People can inject drugs into muscles (intramuscular or IM), into veins (intravenous or IV) or subcutaneously (into the tissue beneath the skin - sometimes called ‘skin popping’).  Injecting drugs usually results in the effects coming on quickly and strongly and wearing off faster.  

You may want to consider doing these things if you decide to inject drugs:  

Use smaller amounts. 

Because injecting drugs delivers them to your body much faster, there is an increased risk of overdose. Consider starting with a smaller amount.  

 

Visit a local needle exchange. 

They can show you safer injecting techniques and provide you with information on how to stay safer. Many of these services are run by peers who understand the experiences of people injecting drugs.  Learning how to inject in a safer way can reduce your risk of damaging your veins or getting an infection. Find your local needle exchange here.  

There are also other injecting resources with tips to stay safer, like the Harm Reduction Coalition’s handbook.   

 

Use new needles and injecting equipment every single time you inject.

Using new equipment every time you inject (including sterile water, alcohol wipes, filters, and other gear) reduces your risk of infections and skin or vein damage. Do not share needles or other injecting equipment with others as this can lead to the transmission of diseases such as HIV or hepatitis C.  

If you are reusing a needle, reuse your own, rather than someone else’s. The needle exchange has tips about how to clean your syringe. Use the 2X2X2 method they recommend- flush 2x with cold water, 2x with bleach, alcohol, or peroxide; and then 2x water again. This won’t get rid of all bacteria or bugs, but it will reduce the risk.  

Needles, syringes and injecting equipment are free at needle exchanges across New Zealand  

 

Keep your injection site clean.

Use alcohol pads or wipes to clean the area before you inject and wash your hands thoroughly before using. Use a gentle cleaner after you have injected to clean off the area and keep it dry. Using alcohol pads directly on the injection site after you have used will make it bleed more.  

 

Rotate injecting sites and stop if you experience redness or soreness in the area.

If you use the same site regularly, this can cause damage to the tissue and increase your risk of infection. If you overuse a site, you may experience vein collapse. The area around the site may become painful, swollen, or hard. If this happens take a break from injecting in the area. Marking your veins with a pen in good lighting, can reduce the chance of missing the shot.

The Needle Exchange has great information about injection site care here.  

 

Know the signs of infection.

Your injection site may be a little tender or red right after injecting, but lasting soreness, redness, or swelling can indicate a more serious problem. If your injection site becomes quite sore, swollen, inflamed, contains pus, has a foul odour, has ulceration (sore with hard edges), blistering or changes in colour, seek advice from a healthcare professional as soon as possible. 

If you are experiencing any of the changes above and also have signs of a fever or flu-like symptoms, you should seek urgent medical care. This can be a sign of more serious infection. 

  

Avoid injecting in sites with higher risk.

Some are injection sites carry greater risk of harm than others. Generally, the arms are the safest places to inject drugs into a vein (IV). The groin and the neck are risky injection sites. The groin contains the femoral vein which people sometimes inject into, but it is very close to the femoral artery which is very dangerous if hit. Similarly, veins in the neck are close to the carotid artery, which is very dangerous to hit. You can see a breakdown of different sites and their risks here. 

 

Filter your drugs before injecting them.

Filtering drugs removes impurities, bacteria, and binders and fillers that can be dangerous to inject. You can get a variety of filters from your local needle exchange for free. It is extra important to filter pills, as these can have harmful fillers that can be dangerous if injected.   

Using a wheel filter is the safest option. Pieces of cotton from cotton/cigarette filters can break off and get into your bloodstream and cause an illness called ‘cotton fever’.   

You can find more information about filtering drugs from the Needle Exchange here.  

 

Extra tips

  • Some drugs can be dangerous to inject into the muscle. This includes methamphetamine and cocaine. Injecting these drugs very commonly leads to abscesses and other complications.  
  • Inject in safer spots and rotate them. The outside upper arms, outer thigh, and buttocks are the safest muscles to inject into. Make sure you avoid nerves, veins and arteries and rotate your injection site to reduce your risk of bruising, infections, and abscesses.  
  • Use a sterile needle each time you draw up for injection. Take extra care when drawing up from a rubber stopper vial. Using a non-sterile needle or coring the rubber can cause the whole vial to be contaminated.  
  • As a general rule, insert the needle at a 90-degree angle to the body. If you pull back on the plunger and there is blood, then you have hit a blood vessel. Visit a needle exchange for more information.  
  • Inject with the bevel of the needle pointing up and the needle pointing in the same direction as the blood flow (toward your heart).  
  • Visit a Needle Exchange for guidance on technique and the appropriately sized needle. Needles over 27 gauge are not meant for IV injecting. 
  • If prepping a shot with acid, use the smallest amount possible to avoid damage to the veins. Citric acid or ascorbic acid (Vitamin C) are safer options than lemon juice or vinegar.  
  • Never inject into an artery. If it has a pulse, it is an artery. If you inject into a site and see bright red/pink or frothy blood coming into the syringe, you have hit an artery. Apply pressure immediately and seek medical attention. If you hit an artery in your neck or groin, call 111 for an ambulance as this can be fatal.  
  • Getting your veins up before injecting will help avoid a missed shot. Keeping hydrated, pumping your fist or using a warm compress will raise veins. If using a torniquet, use a medical grade one from a Needle Exchange rather than a belt or tie. Make sure it is not too tight and can be removed easily once you are in a vein.   
  • This will deliver drugs more slowly to your body than injecting into the veins. Because of this, it’s important to wait about an hour to feel the full effects before deciding whether to use more.  
  • Visit a Needle Exchange for guidance on technique and the appropriately sized needle. Generally, it is recommended to use a short, thin gauge needle, inserted at about 45 degrees. 
  • Areas such as the upper arm, stomach, and thigh are often used for subcutaneous injections 
  • There is a high risk of developing abscesses with these injections, especially if a drug has not been properly filtered using a wheel filter.